Note: your password will be used to update your volunteer
record after submission.

Emergency contact name:

Emergency contact phone:

How did you hear about the event:

Volunteer opportunities:

EMS/RN

General Support

WAIVER

I know that running, walking or volunteering at a roadrace,
regardless of the distance, is a potentially hazardous activity. I should not
enter and participate unless I am medically able. I agree to abide by any
decision race official relative to my ability to safely support this roadrace
and I further agree that race officials may authorize necessary emergency
treatment for me. I also understand that police protection will not be
provided, both vehicle traffic and spectators will be present along the course
and I assume the risk of supporting an event under such conditions. I further
assume any and all other risks associated with supporting the 100on100 Relay
(hereinafter "the event") including, but not limited to illness, traveling to
and from the event, falls, contact with spectators or other participants, the
effects of the weather (including temperature extremes and humidity) and the
surface condition of the roads, all such risks being known and appreciated by
me. Having read this waiver and knowing these facts, and in consideration of
the acceptance entry, I hereby for myself, my heirs, my executors,
administrators or anyone else who might claim on my behalf, covenant not to
sue, and waive, release and discharge all towns, race officials, volunteers and
any and all other sponsors, suppliers, agents, independent contractors,
employees and any other personnel in any way assisting or connected with this
event from any and all claims or liability of any kind or nature whatsoever
arising out of my participation in this event, even though that liability may
arise out of negligence or carelessness on the part of the persons.

To the extent that statute or case law does not prohibit
releases for negligence, this release is also for negligence. If any portion of
this release from liability shall be deemed by a Court of competent
jurisdiction to be invalid, then the remainder of this release from liability
shall remain in full force and effect and the offending provision or provisions
severed here from. By signing this release, I acknowledge that I understand its
content and that this release cannot be modified orally. I consent to allow my
picture or likeness to appear in any official documentary, sponsor
advertisement or television coverage of the event for any legitimate
purpose.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTANDING THAT
I GIVE UP SUBSTANTIAL RIGHTS BY SUBMITTING THIS FORM, AND DO SO SUBMIT THE FORM
VOLUNTARILY.